Third Quarter CDM Updates – Effective July 1, 2013

To summarize, there have been new APCs assigned, deletions, revisions to descriptions and status indicator changes. It is crucial that your CDM is updated to reflect the new information and codes available to ensure correct coding and reimbursement. Team education is also crucial, be sure to share the new information with everyone to improve reimbursement potential.

HCPCS C1879 Tissue Marker Implantable will be deleted on June 30, 2013 and replaced with new HCPCS code A4680 Tissue Marker Implantable, any type which will be effective July 1, 2013.

New HCPCS and Category III CPT Codes:

HCPCS

CodeDesc

SI

APC

Edit

ActivDate

G0460

Autologous PRP for ulcers

T

00013

20120802

HCPCS

CodeDesc

SI

APC

0329T

Mntr io press 24hrs/> uni/bi

E

00000

0330T

Tear film img uni/bi w/i&r

S

00230

0331T

Heart symp image plnr

S

00398

0332T

Heart symp image plnr spect

S

00398

0333T

Visual ep acuity screen auto

E

00000

0334T

Preq stablj sacroiliac joint

T

00208

C9131

In ado-trastuzumab emtansine

G

09131

C9736

Lab ablate uteri fibroid rf

T

09131

K0008

Cstm manual wheelchair/base

Y

00000

K0013

Custom power whlchr base

Y

00000

K0900

Cstm dme other than wheelchr

Y

00000

Q0090

Skyla 13.5mg

E

00000

Q2033

Influenza Vaccine, (Flublock)

L

00000

Q2050

Doxorubicin inj 10mg

K

07046

Q2050

Zoldedrionic acid 1mg

K

01356

Revisions to Code Descriptions:

C9734 Focused ultrasound ablation/therapeutic intervention, other than uterine leiomyomata, with or without magnetic resonance (MR) guidance which was added April 1, 2013 has a revised description effective July 1, 2013. The new description has been revised to delete the words “or without”.

C9297 this description change is dated back to 4/1/13. The old description is Omacetazine mepesuccinate and the new description is Omacetaxine mepesuccinate.

72040 had an old description of radiologic examination, spine, cervical; 3 views or less and the new description is Radiologic examination, spine, cervical 2-3 views.

HCPCS

Old Description

New Description

Q0509

Mis sup/ac imp vad nopay med

Mis sup/ac imp VAD nopay med

Q5001

Hospice in patient home

Hospice or home hlth in home

Q5002

Hospice in assisted living

Hospice/home hlth asst lv

Q5009

Hospice care, NOS

Hospice/home hlth, place NOS

The following represent changes to Status Indicators and Edit Assignments that have been made effective back to January 1, 2013.

HCPCS

Short Code Description

Old SI

New SI

Old Edit

New Edit

81500

Onco (ovar) two proteins

A

E

N/A

9

81503

Onco (ovar) five proteins

A

E

N/A

9

81506

Endo assay seven anal

A

E

N/A

9

81508

Ftl cgen abnor two proteins

A

E

N/A

9

81509

Ftl cgen abnor 3 proteins

A

E

N/A

9

81510

Ftl cgen abnor three anal

A

E

N/A

9

81511

Ftl cgen abnor four anal

A

E

N/A

9

81512

Ftl cgen abnor five anal

A

E

N/A

9

90686

Flu vac no prsv 4 val 3 yrs+

E

L

28

N/A

The following codes had an APC or SI change. Also noted are the edit changes. Effective July 1, 2013

HCPCS

CodeDesc

Old APC

New APC

Old SI

New SI

Old Edit

New Edit

A9700

Echocardiography Contrast

B

N

62

N/A

J3487

Zoledronic acid

09115

00000

K

E

N/A

28

J3488

Reclast injection

00951

00000

K

E

N/A

28

J9002

Doxil injection

07046

00000

K

E

N/A

28

Q4122

Dermacell

K

G

Q4126

Memoderm/derma/tranz/integup

00000

01452

E

K

9

N/A

Q4134

hMatrix

00000

01453

E

K

28

N/A

New APCs: Effective July 1, 2013

APC

APCDesc

StatusIndicator

01356

Zoldedronic acid 1mg

K

01452

Memoderm/derma/tranz/integup

K

01453

hMatrix

K

09131

In ado-trastuzumab emtansine

G

Deleted APCs:

APC

APCDesc

00951

Reclast injecetion

09115

Zoledronic acid

APC Description Changes:

APC

Old Description

New Description

07046

Doxil injection

Doxorubicin inj 10mg

09297

Omacetazine mepesuccinate

Omacetaxine mepesuccinate

Status Indicator Changes:

APC

Old SI

New SI

01419

K

G

CPT Code Changes:

The following codes have been added retrospectively to the conditional bilateral list effective January 1, 2013. When these new codes came out in January 2013 the instruction was that these were unilateral codes and coders were to use once per date of service for each extremity. As it turns out, CMS has made a change in the outpatient code editor version 14.2.

37211 Transcatheter therapy, arterial infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, initial treatment day.

92071 Fitting of contact lens for treatment of ocular surface disease. Additionally, this same code was removed from the independent bilateral list on the same effective date of January 1, 2013.

New Modifier:

JE: ESRD facilities to append a new modifier, JE (Administered via Dialysate) to all ESRD claims where drugs and biologicals are furnished to ESRD beneficiaries via the dialysate solution for claims with dates of service on or after July 1, 2013.

Procedure Device Pair Changes: Code pair requirements. These two codes have been retro activated back for an effective date of January 1, 2013: